Lithuanian University of Health Sciences, Oncology Institute, Kaunas, Lithuania.
Acta Otorhinolaryngol Ital. 2012 Oct;32(5):297-303.
The aim of the present study was to evaluate the results of hypofractionated accelerated CT-guided interstitial HDR-BRT using 2.5 Gy per fraction. From December 2008 to March 2010, 30 patients were treated for recurrence of previously-irradiated head and neck cancer. Thirteen patients underwent surgical resection followed by HDR-BRT to the tumour bed. Seventeen patients were treated with HDR-BRT only. All patients received 2.5 Gy twice per day for a total dosage of 30 Gy. The overall survival rate (OS) for the entire group at 1 and 2-years was 63% and 47%, while local control (LC) was 73% and 67%, and disease-free survival (DFS) was 60% and 53%, respectively. Patients treated with surgical resection and HDR-BRT showed an improvement in both 2-year LC (77% vs. 47%, p = 0.013) and 2-year OS (62% vs. 35%, p = 0.035) compared to patients treated with HDR-BRT only. Median OS for pre-treatment tumour volumes ≤ 36 cm3 was 22 months and 9.2 months for those > 36 cm3 (p = 0.038). Grade III and IV late complications occurred in 3% of patients. There were no grade V complications. The interstitial HDR brachytherapy regimen using 2.5 Gy twice daily fractions at a total dose of 30 Gy offers an effective treatment option for patients with recurrent previously-irradiated head and neck cancer with a low rate of late high grade toxicity. Surgical resection had a positive effect on survival and local control in management of patients with recurrent head and neck cancer.
本研究旨在评估每日两次、每次 2.5Gy 分割剂量、共 30Gy 的低分割加速 CT 引导间质内 HDR-BRT 的治疗效果。2008 年 12 月至 2010 年 3 月，30 例复发性头颈部癌患者接受了治疗。其中 13 例患者接受了手术切除，随后对肿瘤床进行 HDR-BRT 治疗；17 例患者仅接受 HDR-BRT 治疗。所有患者均接受每日两次、每次 2.5Gy 的分割剂量，总剂量为 30Gy。全组患者的总生存率（OS）在 1 年和 2 年时分别为 63%和 47%，局部控制率（LC）分别为 73%和 67%，无疾病生存率（DFS）分别为 60%和 53%。与单纯接受 HDR-BRT 治疗的患者相比，接受手术切除联合 HDR-BRT 治疗的患者在 2 年 LC（77% vs. 47%，p=0.013）和 2 年 OS（62% vs. 35%，p=0.035）方面均有改善。治疗前肿瘤体积≤36cm3 的患者中位 OS 为 22 个月，肿瘤体积＞36cm3 的患者中位 OS 为 9.2 个月（p=0.038）。3%的患者发生 3 级和 4 级晚期并发症，无 5 级并发症。对于复发性头颈部癌患者，每日两次、每次 2.5Gy 分割剂量、共 30Gy 的间质内 HDR 近距离放疗方案是一种有效的治疗选择，晚期重度毒性反应发生率低。手术切除对头颈部癌复发患者的生存和局部控制有积极影响。
